Autumn is here and the rain and wind may have you retreating to the sofa to snuggle with hot drinks rather than get out and about walking or exercising.  However, the benefits of braving the cold may actually warm the heart!  A new study (1) has found that any amount of physical activity appears to lower the risk of death among women and men with already diagnosed coronary heart disease.  On the 31st July I wrote about physical activity and the prevention of cancer and with World Heart Day fast approaching (28th September) I thought it apt to mention this newly published study.

Individuals with heart disease frequently limit the amount of physical activity they partake in due to symptoms such as shortness of breath, chronic fatigue and circulatory problems.  The researchers of this study wanted to investigate the long-term effects of exercise in individuals with existing heart disease.  The study involved 14,021 people followed for an average of 14.7 years.  The researchers categorised their physical activity into four levels – sedentary, mild, moderate and strenuous.

The results showed that the risk of death from cardiovascular problems increased significantly with less physical activity.  The more active an individual was, the lower the risk of death from cardiovascular problems.  This trend was similar in men and women.  Over the course of the study, the death rate was lowest among men and women involved in strenuous recreation such as endurance activities or competitive team sports.  The death rate was highest among men and women reporting sedentary leisure activities that primarily involved sitting.  Sedentary individuals were 1.6 times more likely to die from cardiovascular disease or other causes over the long term compared to those more physically active.

The study concluded that “leisure-time physical activity independently predicted long-term survival in men and women with chronic stable CHD[coronary heart disease]”

If you suffer from heart problems ALWAYS make sure that you check with your GP or specialist before embarking on a new exercise regimen and seek advice on the best form of exercise for you to try.  Walking and swimming are often recommended as good, gentle, ways to get started. 

(1) Apullan MD et al.  2008.  Usefulness of Self-Reported Leisure-Time Physical Activity to Predict Long-Term Survival in Patients With Coronary Heart Disease.  Am J Cardiol. 102:375-379

Written by Ani Kowal

Following on from Monday, here are some more important dietary and lifestyle factors that may help to prevent prostate problems:

Lycopene is an antioxidant carotenoid that I have mentioned a few times in my blog posts.  It can be found within red/orange coloured fruits and vegetables such as tomatoes, watermelon, pink and red grapefruits, guava and papaya .  A review of multiple studies was published this year(1), it discusses the role of lycopene in the prevention of prostate cancer.  The paper states “Based on the evidence from epidemiologic [association/observational studies], animal, in vitro [test tube] and human clinical trials, it is evident that lycopene, a non-provitamin A carotenoid, is a promising agent for prostate cancer prevention”, the authors go on to suggest that larger trials should be implemented in order to assess whether this nutrient could be used as a medical agent for prostate cancer prevention.  If you do not regularly consume lycopene containing foods you may wish to consider a lycopene supplement.  Absorption of lycopene from foods, or indeed supplements, is affected greatly by fat.  Without a fat source lycopene will not be efficiently absorbed into the body so you would do well to find supplements that contain an oil base (there are many available) and dress any salads or vegetables with a little olive oil.  Studies (2,3) also suggest that lycopene may be useful in reducing the risk and progression of BPH.

Again I am going to mention oily fish and the essential omega 3 fatty acids which they contain!  It seems that I mention these essential fats consistently through my blog posts – they are certainly not labelled ‘essential’ for no reason!  Back in 1999 a study(4) in men found that patients with prostate cancer and BPH had significantly lower levels of omega 3 fatty acids in their blood serum compared to healthy men with no signs of either disease.  A study published in 2004(5) involved a cohort of 47,866 men aged 40-75 with no history of cancer at the start of the study (in 1986).  They were followed for 14 years during which time 2965 new cases of prostate cancer were diagnosed, 448 cases being advanced.  A higher intake of the omega 3 fatty acids EPA and DHA (found in oily fish such as salmon, mackerel, sardines and trout) was related to a lower risk of prostate cancer and advanced prostate cancer.  Frequent oily fish consumption has also been strongly associated with a decreased risk of prostate cancer in other studies(6,7). 

Trying to eat at least two portions of oily fish per week would probably benefit multiple health factors, it is yet unknown whether there is a benefit from taking supplemental omega 3 fatty acids for reducing the risk of prostate cancer.  However, if you are not a regular eater of oily fish I would suggest a daily supplement providing around 250g of EPA and 250g of DHA daily.  Since these fatty acids are known to reduce inflammatory markers in the body they may well be helpful in preventing BPH.

Eating well is important for every cell in our body!  A healthy diet could certainly help protect your prostate! 

It is also important for me to mention exercise.  Studies show that men who regularly take some form of physical activity have reduced incidence of BPH and other urinary tract symptoms(8,9).  I am not suggesting a daily pounding of the treadmill in the gym or excessive iron-man measures.  Walking could be enough to help!  One study(9) found that walking for 2-3 hours per week was associated with a 25% reduced risk of having BPH compared to those not walking.  Choose an activity you enjoy, something that gets you moving a few times per week.

(1)Dahan M et al.  2008.  Lycopene in the prevention of prostate cancer.  J Soc Integr Oncol.  6:29-36
(2)Kristal AR et al.  2008.  Dietary patterns, supplement use, and the risk of symptomatic benign prostatic hyperplasia: results from the prostate cancer prevention trial.  Am J Epidemiol.  167:925-934
(3)Schwarz S et al.  2008.  Lycopene inhibits disease progression in patients with benign prostate hyperplasia.  J Nutr.  138:49-53
(4)Yang YJ et al.  1999.  Comparison of fatty acid profiles in the serum of patents with prostate cancer and benign prostatic hyperplasia.  Clin Biochem.  32:405-409.
(5)Leitzmann MF et al.  2004.  Dietary intake of n-3 and n-6 fatty acids and the risk of prostate cancer.  Am J Clin Nutr.  80:204-216
(6)Hedelin M et al.  2007.  Association of frequent consumption of fatty fish with prostate cancer risk if modified by COX-2 polymorphism.  Int J Cancer.  120:398-405
(7)Augustsson K et al.  A prospective study of intake of fish and marine fatty acids and prostate cancer.  Cancer Epidemiol Biomarkers Prev.  12:64-67
(8)Orsini N et al.  2006.  Long-term physical activity and lower urinary tract symptoms in men. J Urol.  176:2546-50
(9) Platz EA et al.  1998.  Physical activity and benign prostatic hyperplasia.  Arch Intern Med.  158:2349-56.

Written by Ani Kowal

Broccoli, of all things, drew me into writing about prostate problems!  It is being consistently branded as a ‘superfood’ and recently a study found that eating just a few portions of broccoli each week could really go far to protect men from prostate cancer(1).

The most common prostate problem in men over 50 years of age is benign (non harmful/cancerous) enlargement of the prostate gland, known as Benign Prostatic Hypertrophy (BPH).  This noncancerous condition tends to cause an impediment in the flow of urine and often an increased frequency of urination, especially at night.  Sometimes men also experience a difficulty in urinating or a weak flow stream. 

BPH is the most common cause of prostate enlargement, however, prostate cancer can cause similar symptoms and so it is ALWAYS important to visit a GP in the first instance before deciding to follow any natural guidance for BPH.  The good news is that BPH responds very well to nutritional approaches (any programme may take 6-8 weeks to produce results).

Today I am going to talk about BPH and prostate cancer prevention as both are linked to similar nutrients and dietary advice.  It is important to talk about prostate cancer as it is the most frequently diagnosed non-skin cancer within the male population of western countries.

Back to the broccoli!  Multiple studies have linked the eating of diets rich in fruit and vegetables to a reduced risk of prostate cancer, however the broccoli study(1) is the first human trial which investigated the mechanisms behind the positive results.  Amazingly the broccoli seemed to be switching on genes in the body which prevent cancer developing and switching off genes which usually help cancer to spread.  Broccoli is a cruciferous vegetable, as are brussel sprouts, cauliflower, cabbage, rocket, watercress and horseradish.  Cruciferous vegetables contain compounds called isothiocyanates, responsible for the bitter taste, these are likely to be providing the cancer-prevention benefit.  

Other studies have also suggested that consuming one or more portions of broccoli per week can reduce the risk of prostate cancer(2).  Different fruits and vegetables probably work through different mechanisms (for example through their anti-oxidant potential) and so providing a wide variety in the daily diet will confer the best protection to health!

One nutrient that is gaining attention for its cancer preventative prospects is Selenium.  Here in the UK many of us will not obtain much selenium from our diets because our soils are fairly deficient and so agricultural crops contain less selenium than from elsewhere in the world.  Since reducing our wheat imports from the USA our selenium intakes have dropped.  One sure fire way to provide ourselves with enough of this essential mineral is to eat Brazil nuts!  These nuggets are packed with selenium and just 5-6 a day would be beneficial!  A review paper has just been released(3) which assessed several observational and supplement studies that support a preventative effect of selenium against prostate cancer. 

Evidence suggests that selenium acts via multiple mechanisms and pathways, most-notably through its anti-oxidative and anti-inflammatory effects.  Selenium is an integral constituent of many hundreds of enzymes which work in most cells throughout the body and so it is not surprising that it shows anti-cancer potential.  Although larger-scale trials are needed it is, in my opinion, necessary that we make sure that our diets contain adequate amounts of this nutrient.  It is an essential mineral that the body cannot do without and so it seems prudent to at least provide the minimum amounts needed for health.  If you are not a regular consumer of Brazil nuts then you may wish to consider a supplement.  However, single nutrient supplements are not something that I recommend.  If you already take a multi-vitamin and mineral supplement check to see if it contains Selenium.  There is no current recommendation but many health professionals recommend at least a minimum of 35µg (micrograms) a day and no more than 200 µg a day (selenium in high doses can be toxic).  Many multivitamin-mineral supplements provide 75µg. 

Check back later in the week for part II

(1)Traka M, Gasper AV, Melchini A, Bacon JR, Needs PW, et al. Broccoli Consumption Interacts with GSTM1 to Perturb Oncogenic Signalling Pathways in the Prostate. PLoS One, 3(7): e2568 DOI: 10.1371/journal.pone.0002568
(2)Joseph MA et al.  2004.  Cruciferous vegetables, genetic polymorphisms in glutathione S-transferases M1 and T1, and prostate cancer risk.  Nutr Cancer 50:206-213
(3)Peters U & Takata Y.  2008.  Selenium and the prevention of prostate and colorectal cancer.  Mol Nutr Food Res.  Sep 2 [EPub ahead of print]

Written by Ani Kowal

My last posting concentrated on new evidence suggesting that desk work could be contributing to overeating.  Staying on the work theme I wanted to briefly mention a recent(1) study published by ComPsych Corporation that reveals how healthy eating seems to improve our energy levels at work.

ComPsych Corporation is the world’s largest provider of employee assistance programs, operating in 92 countries.  They also provide services to address employee behavioural health, wellness and work-life balance.  Their 2008 workplace wellness study, which surveyed over 1000 employees in the US, revealed that 50% of workers with balanced diets have high energy compared to only 5% with those with unbalanced diets.  In addition to the aforementioned results the study also found that of the employees with healthy diets 73% reported having high levels of productivity compared to 24% of employees with poor dietary habits.  51% of employees who were not overweight had high morale compared to 25% who were overweight.

It seems obvious to me that continual feelings of high energy will help keep us motivated and hence productive at work.  Healthy eating can impact us in many ways.  Providing the body with optimal nutrition will keep us functioning well both mentally and physically.  Not rocket science really!

In the last post I mentioned the stress hormone cortisol and the possible effects of work on our blood sugar balance.  ‘Stress’ within the workplace is really a ‘fight or flight’ response to a mental challenge but it can become a problem when it is too much for an individual to handle.  Hormones such as cortisol and adrenaline flood the body during stressful times and cause digestion to slow, muscles to tense, heart rate to rise and blood sugar levels to fluctuate.  In a situation such as a tiger about to attack us this is a beneficial response as we use all our energy to flee the scene!  If we are at our desks in a work situation and this energy and tension is not discharged it starts to have an effect all of our organs and cells which can lead to health problems ranging from high blood pressure to digestive problems, sleep problems and even cancers.  Each of us responds differently under pressured situations so stress is a very personal issue.  There are many ways that we can attenuate the negative effects of too much work and mental pressure.  Exercise, relaxation, avoiding caffeine, reducing alcohol levels, making room for fun and eating a balanced and healthy diet can all help.

In addition to ensuring a diet that is as healthy as possible there are a few specific nutrients which may help support the body during times of stress.

Stress seems to promote the release of inflammatory chemicals in the body.  Omega 3 fatty acids may inhibit the ability of excess stress to initiate inflammation.  Excessive amounts of omega 6 fatty acids (found in vegetable oils), and a relative lack of omega 3 fatty acids (found in oily fish and some nuts and seeds) also seems to promote inflammation in the body. Maintaining a balance of omega 6 and omega 3 fatty acids i.e. avoidance of excessive amounts of margarine and vegetable oils and the regular inclusion of oily fish (e.g. salmon and mackerel), walnuts and flaxseeds in the diet may therefore benefit individuals during times of stress.  In one(2) study twenty-seven university students had their blood serum sampled a few weeks before and after, as well as one day before, a difficult oral examination (a time of considerable stress).  This stress was associated with a significant increase in the production inflammatory chemicals in the body (cytokines).  Subjects with high omega-6 fatty acid levels had a greater production of these inflammatory cytokines compared with subjects with high omega-3 fatty acid levels. Another study (3) found that supplementation with fish oils inhibited the release of the stress hormones adrenaline and cortisol in response to mental stress.  If you are not a regular eater of oily fish you may wish to consider a supplement that provides around 250mg of EPA and 250mg of DHA (long chain omega 3 fatty acids) daily.  Or, if you are vegetarian/vegan, a daily flaxseed oil supplement providing around 500mg alpha-linoleic acid.

Another useful nutrient during times of stress is the mineral magnesium.  Studies have shown that excessive stress may cause the depletion of magnesium within the body (4,5).  Many people in the UK do not get enough magnesium in their diets.  Rich sources include nuts, seeds, pulses (beans, chickpeas) and wholegrain cereals.  If you feel you are not regularly eating these foods you may wish to consider a supplement providing around 300mg of magnesium a day.  

Finally I would like to mention gut bacteria (for more information see IBS post part I). Studies have shown that excessive stress can cause the depletion of beneficial ‘good’ bacteria (such as species of lactobacilli and bifidobacteria) in the intestinal tract (6) Individuals may therefore benefit from taking a probiotic and prebiotic in times of stress.  One study(7) evaluated the use of a probiotic multivitamin supplement in 42 adults suffering from stress or exhaustion.  The supplement was taken daily for 6 months.  At the end of the study, an overall 40.7% improvement in stress was noted.  In addition, decreases of 29% in the frequency of infections and of 91% in gastrointestinal discomforts, both established indicators of stress, were recorded.  This was probably due to a combination of both the vitamins and the probiotics.  It is also known that stress can cause depletion of certain antioxidant vitamins in the body.

A balanced diet that prevents fluctuations in blood sugar levels (see post dated Monday 8th September) that includes a variety of vegetables and fruits together with healthy fats from nuts, seeds and oily fish and minimal amounts of processed and refined foods will really help to support the body during times of stress (well at all times really!)

(1)ComPsych 2008 Health and Productivity Index.
(2)Maes M  et al.  2000.  In humans, serum polyunsaturated fatty acid levels predict the response of proinflammatory cytokines to psychologic stress.  Biol Psychiatry.  47(10):910-920.
(3)Delarue, J., et al.  Fish oil prevents the adrenal activation elicited by mental stress in healthy men.  Diabetes Metab.  29(3):289-295, 2003.
(4) Johnson S et al.  2001.  The multifaceted and widespread pathology of magnesium deficiency.  Medical Hypotheses.  56(2):163-170.
(5) Cernak I et al.  2000.  Alterations in magnesium and oxidative status during chronic emotional stress.  Magnes Res.  13:29-36
(6)Lizko NN et al.  1984.  [Events in the development of dysbacteriosis of the intestines in man under extreme conditions.]  Nahrung.  28:599-605.
(7)Gruenwald J et al.  2002.  Effect of a probiotic multivitamin compound on stress and exhaustion.  Adv Ther.  19(3):141-50

Written by Ani Kowal

Many of us now work at desk jobs which require the expenditure of very little physical energy but need a lot of mental concentration.  This sedentary lifestyle could certainly be adding to the overweight/obesity increases occurring in the UK and beyond.  If we take in more calories than we use then the excess is stored in the body and our waist-lines expand.  However, a very interesting study(1) has just been published which suggests that desk-jobs requiring mental, but not physical, activity could be affecting our body chemistry in ways that may lead to our overeating.  If this extra energy consumption is not then expended through exercise it can lead to weight gain.

An earlier, preliminary, study(2) by the same authors last year found that knowledge-based work, sitting for 45minutes reading a document and writing a 350 word summary using a computer, required an average of only 3 calories more energy than resting in a sitting position for 45minutes.  However, after the knowledge-based work individuals consumed 229calories more (at an unrestricted buffet) than after 45 minutes rest.  According to the assessment questions, markers of appetite sensation had not changed between the two sitting conditions.  In addition to this, the test subjects did not compensate by decreasing food intake or increasing energy expenditure for the rest of the day. 

The researchers wanted to look deeper at the phenomenon and hence their most recent study(1).  In this small experiment the researchers investigated 14 women (who were not over- or underweight).  Each individual went through the following 45minute test ‘conditions’
-Resting in a sitting position
-Reading a document and writing a summary on the computer
-Performing a number of different computerised tests
The blood (plasma) glucose levels, insulin levels and cortisol (a hormone) levels were measured seven times during each experimental condition.  Appetite sensations were also measured via a questionnaire and following the tests there was a buffet where the participants could eat what they liked.

After the reading/writing test the individuals ate, on average, 203 calories more than they did after rest.  After the computerised tests they ate an average of 254 calories more than they did after a 45minute rest.  There was no difference in the appetite sensations recorded among the three different test conditions.  In summary the study(1) showed that knowledge-based mental work induces significant increases in calorie intake which could, over a long-term period, be a risk factor for overweight. 

The interesting point is that there was also a difference between the body chemistry measured.  The average cortisol levels were significantly higher in the two knowledge-based work conditions (the reading/writing and computerised test) compared to the rest condition.  There was also a significant increase in variations in glucose and insulin levels compared to rest.  These biochemical markers can provide insight into why mental work can induce overeating.  They also present possible solutions!!

The fluctuating cortisol, glucose and insulin levels could be the trigger for over eating.  Cortisol is often known as the stress hormone.  Under periods of pressure our cortisol levels rise and there is suggestion that high levels can unbalance blood sugar control in the body (which has knock-on effects for the amount we consume).  The fluctuating glucose and insulin levels may well be contributing to over-eating.  The body is a very clever machine!  Our brain uses glucose in order to function, so perhaps the fluctuations are triggering increased food intake.  The problem is that; since we are not increasing physical activity there is a calorie over compensation and the extra food we take in to balance out the blood sugar fluctuations is not expended by increased physical activity.
 

Personally I think the key for desk-based workers is to try and provide the body with a slow and steady supply of energy throughout the day, this should prevent the blood sugar fluctuations which may be leading to over-eating.  My advice would be to start the day with a breakfast containing a protein source e.g. an egg/nuts/seeds/yoghurt (be wary of low fat yoghurt as these are often packed full of added sugar) together with some unrefined carbohydrate which releases sugar slowly (one that has a low glycaemic index) such as oats or some fruit salad.  If you can avoid caffeinated tea or coffee then this could also help.  The caffeine can disrupt blood sugar balance.  The lunchtime sandwich often leads to a mid-afternoon energy slump that leave us reaching for a sugar fix.  Bread is starchy and releases sugar very quickly into the bloodstream.  The body responds with a surge of insulin which can cause a subsequent sugar low a few hours later at mid-afternoon and consequent feelings of lethargy.  It may be preferable to try basing your lunchtime meal around a portion of protein (unprocessed meat, fish, eggs, beans) together with 2-3 portions of vegetables/salad.  This kind of meal will provide the body with a steady source of energy throughout the afternoon.  If you do find your energy levels dropping try eating a few unsalted/un-blanched nuts.

Desk work needn’t cause havoc with our waistlines!  Of course, trying to take some kind of daily exercise is also very important.  Even a half hour walk or taking the stairs, it all helps.  Exercise also helps to regulate appetite and food intake.  A holistic approach is certainly the way to go!

(1)Chaput JP et al.  2008.  Glycemic instability and spontaneous energy intake:association with knowledge-based work.  Psychosom Med.  [E-pub before print August 25 ] doi:10.1097/PSY.0b013e31818426fa
(2)Chaput JP&Tremblay A.  2007.  Acute effects of knowledge-based work on feeding behavior and energy intake.  Physiol Behav.  90:66-72

Written by Ani Kowal

Continuing with the theme of child health I have decided to look at the prevention of common infections such as those of the ear, nose and throat, and tummy upsets.  Children returning to school after the long holiday break will be exposed to others who they may not have seen in weeks and also to the various ‘bugs’ that they may be carrying.  Fear not, it is not inevitable that your children will end up feeling poorly and catching every illness around them! 

A healthy, strong immune system will help to prevent various infections, or keep them short and less intense if they do occur.  Ensuring that your child is eating healthily will mean that they are getting all the vitamins, minerals and essential fatty acids they need in order to keep their immune system fighting fit.  However, I am aware that many children are not regularly getting the recommended daily 5 portions of fruit and vegetables.  This may mean that they are lacking in essential nutrients and their immune system may not be running at optimum.  Certain supplements, specially formulated for children, may be helpful in supporting a healthy diet in order to keep the immune system healthy.  However, a supplement cannot be seen as a replacement for the foundations provided by a healthy lifestyle.

Here I will be looking at some of the evidence which suggests that a multivitamin and mineral supplement taken together with a fish oil supplement (to provide essential omega 3 fatty acids) and a pre/pro-biotic supplement could be useful in helping to prevent childhood infections. 

Two papers have been published by a group of researchers who used a fish oil and multivitamin-mineral supplement in children who regularly suffered from recurrent ear(1) and sinus(2) infections.  The studies were very small and preliminary but both suggested benefit in the prevention of these common childhood conditions.  The researchers suggest that such preventative treatments could reduce the need for prescribed antibiotics.  Evidence also exists to suggest that individuals who suffer from recurrent tonsillitis infections may have a disturbed balance of various vitamins(3,4) and minerals(5), especially lowered zinc levels.

Previously I have written about zinc and vitamin C in relation to the prevention and shortening of the common cold and I would recommend you visit this post for more information. 

A few months ago I wrote about the importance of maintaining a good balance of ‘friendly’ bacteria in the digestive system in order to boost immune function and how evidence suggests that taking a daily probiotic supplement may prevent the occurrence of the common cold.  Children who have suffered from recurrent infections will normally have been exposed to frequent courses of antibiotics.  Antibiotics may indeed have been useful for fighting the bacterial infection, however they also kill many of the beneficial bacteria that would normally live in a healthy gut.  This imbalance could lead to a less efficient immune system and an increased likelihood of further infections.  One study(6) revealed that; in children with acute infections of the upper and lower respiratory tract, such as bronchitis and pneumonia, a probiotic supplement seemed helpful in regulating the immune system.  A recent review paper(7) indicated that probiotics also have immune enhancing effects in children and may prevent infections and diarrhoea. 

A daily supplement containing probiotics and prebiotics (such as FOS fructooligosaccharides) may be worth considering.  For more information on prebiotics and probiotics I would suggest visiting the post on irritable bowel syndrome which defines and explains these supplements.

When considering multi-nutrient supplements I would suggest a child-specific ‘food-state’ supplement as these will be easily absorbed by the body.  Again I would like to stress that supplements should not be seen as a substitute for a healthy, balanced diet plentiful in a variety of colourful fruits, vegetables and healthy fats. 

Best wishes to all children for an enjoyable first term back at school!

(1)Linday LA, Dolitsky JN, Shindledecker RD, Pippenger CE. 2002.  Lemon-flavored cod liver oil and a multivitamin-mineral supplement for the secondary prevention of otitis media in young children: pilot research. Ann Otol Rhinol Laryngol.  111(7 Pt 1):642-52.
(2)Linday LA, Dolitsky JN, Shindledecker RD.  2004.  Nutritional supplements as adjunctive therapy for children with chronic/recurrent sinusitis: pilot research. Int J Pediatr Otorhinolaryngol.  68(6):785-93.
(3)Aleszczyk J et al.  2001.  [Evaluation of vitamin and immune status of patients with chronic palatal tonsillitis][Polish Article].  Otolaryngol Pol.  55:65-67
(4)Shukla GK et al.  1998.  Comparative status of oxidative damage and antioxidant enzymes in chronic tonsillitis patients.  Boll Chim Farm.  137:206-209
(5)Onerci M et al.  1997.  Trace elements in children whith chronic and recurrent tonsillitis.  Int J Pediatr Otorhinolaryngol.  41:47-51
(6)Lykova EA, Vorob'ev AA, Bokovoi AG, Murashova AO.  2001.  [Impaired interferon status in children with acute respiratory infection and its correction with bifidumbacterin-forte] [Article in Russian].  Zh Mikrobiol Epidemiol Immunobiol.   Mar-Apr;(2):65-7 
(7)Nova E, Wärnberg J, Gómez-Martínez S, Díaz LE, Romeo J, Marcos A. Immunomodulatory effects of probiotics in different stages of life. Br J Nutr. 2007 Oct;98 Suppl 1:S90-5.

Written by Ani Kowal

The long summer holidays have ended and children are heading back into their classrooms.  Over the last few years the press have been giving increasing coverage to a condition known as ADHD (attention deficit hyperactivity disorder).  Today I would like to write about essential fatty acids, one of the many nutritional aspects associated with the condition. 

The following facts were provided by a fantastic charity – Food for the Brain(1) – a non-profit educational charity, created by a group of nutritionists, doctors, psychiatrists, psychologists, teachers and scientists to promote the link between nutrition and mental health.

 
-Children with ADHD often have three basic problems, they can't pay attention, they are hyperactive and they act on impulse.
-It is estimated that up to 5% of school-age children in England and Wales have ADHD – representing around 67,000 children.
-In a class of 30 children there will be one or two children with ADHD.
-Boys seem more likely to have ADHD than girls.
-In the UK, between three and nine boys are diagnosed with ADHD for every girl diagnosed, this may be because boys and girls tend to have different symptoms of ADHD.
-Inattention is more common among girls while hyperactivity is more common among boys.  A boy who is hyperactive (shouting, running about and getting into trouble) may be more noticeable than a girl who is inattentive (daydreaming, forgetful and easily distracted).
-It is estimated that between 30% and 70% of children with ADHD continue to exhibit symptoms in the adult years.

In this blog post I am going to concentrate on the potential usefulness of long chain omega 3 fatty acids (EPA and DHA found in oily fish such as salmon, mackerel, sardines) in the management of ADHD.  These essential fatty acids are crucial to brain development and brain function and increasing evidence indicates that deficiencies or metabolic imbalances of these fatty acids might be associated with childhood developmental and psychiatric disorders including ADHD. Omega-3 are often lacking in modern diets and as I will discuss here, preliminary evidence suggests that supplementation may well be helpful in the management of ADHD and linked behavioural and learning difficulties (such as dyslexia and dysphraxia).

Children with ADHD are often found to have nutrient deficiencies, especially in essential fatty acids(2,3,4). Common symptoms of deficiency may include dry, flaky skin, frequent urination and excessive thirst.  However, symptoms vary or may be absent altogether.

Clinical trials with nutrients and behaviour problems are not easy to conduct as the diagnosis and tracking relies on behavioural criteria and trials do not allow for individual tailoring of treatments.  The data for nutritional management of ADHD is still preliminary but growing rapidly.  Personally I see the links as being exceptionally strong and I know that many other health professionals feel the same way as I do.  The brain needs optimal nutrition to function effectively.  If we are not getting enough vitamins, minerals and essential fatty acids from our diets then we are bound not to be at our best!

One of the leading researchers into learning/behavioural difficulties and nutritional supplementation in the UK is Dr Alexandra Richardson.  Dr Richardson is an inspiration and I have been privileged enough to hear her speak on a number of occasions.  In 2002 she published a paper(5) which detailed a small trial conducted with 41 children, aged 8-12, who had specific learning difficulties (mainly dyslexia) who also showed ADHD features.  The children were given essential fatty acid supplements or a placebo for 12 weeks.  After 12 weeks cognitive (learning/mental) problems and behaviour problems were significantly lower for the group treated with fatty acids.  This small pilot study paved the way for further small studies which all indicate the importance of essential fatty acids in the management of behavioural problems(6,7,8,9).  Unfortunately large scale trials are still needed but funding is notoriously difficult to find for nutritional intervention trials (compared with drug trials). 

Dr Richardson wrote a review paper(10) detailing current thinking around essential fatty acids in childhood developmental and psychiatric disorders.  In it she details the fact that long chain omega-3 fatty acids (EPA and DHA) are often lacking in our diets and that evidence has built up to suggest that deficiencies and/or imbalances are associated with childhood developmental and psychiatric disorders including ADHD, dyslexia, dyspraxia, and autistic spectrum disorders.  The current evidence seems very supportive of dietary supplementation with these fatty acids, particularly EPA (eicosapentaenoic acid).  Dr Richardson stresses the need for large-scale studies to determine optimal treatment formulations and doses and the need to develop ways of identifying individuals most likely to benefit.  She points out “Childhood developmental and psychiatric disorders clearly reflect multifactorial influences, but the study of LC-PUFA [long chain polyunsaturated fatty acids] and their metabolism could offer important new approaches to their early identification and management”

Omega 3 fatty acid supplementation will not help all children affected by ADHD.  However, omega 3 fatty acids are beneficial to health for a number of reasons (which I frequently mention in my blog posts) and, as many of us do not consume oily fish regularly (at least twice per week as a minimum), supplementation seems prudent to make up for the dietary lack. 

A daily supplement providing around 300-500mg of EPA and 250mg of DHA may be worth trying.  The appropriate dose for the improvement of mood and cognition varies.  Some of the trials with ADHD used up to 1000mg EPA.  The quality of the supplement also needs consideration as fish oils may be contaminated with heavy metal residues e.g. mercury.  Supplements containing Vitamin E or C are worthwhile as these vitamins prevent the oil from oxidation (going rancid).  High dose fish liver oils are not recommended as these contain large amounts of vitamin D and A which can be toxic if taken in excess.   

There are many other nutritional factors (vitamins and minerals) associated with ADHD and related conditions and I hope to cover these important topics in time.  Any dietary interventions with children needs to be closely monitored and I would suggest speaking with your GP or health professional before embarking on a regimen.  Dietary interventions are to be viewed as complementary to any other management approaches.  Individual cases need individually tailored treatment. 

Please visit the Food For The Brain website for more ideas and information. 

(1)www.foodforthebrain.org
(2)Burgess JR et al.  2000.  Long-chain polyunsaturated fatty acids in children with attention deficit hyperactivity disorder.  American Journal of Clinical Nutrition.  71(1):327-330.
(3)Mitchell EA, et al.  1987.  Clinical characteristics and serum essential fatty acid levels in hyperactive children. Clin Pediatr.  26:406-411
(4)Stevens LJ et al.  1995.  Essential fatty acid metabolism in boys with attention-deficit hyperactivity disorder. Am J Clin Nutr.  62:761-768
(5)A. Richardson and B. Puri.  2002.  A randomized double-blind, placebo-controlled study of the effects of supplementation with highly unsaturated fatty acids on ADHD-related symptoms in children with specific learning difficulties.  Prog Neuropsychopharmacol Biol Psychiatry, Vol 26(2):233-9
(6)Colter AL et al.  2008.  Fatty acid status and behavioural symptoms of attention deficit hyperactivity disorder in adolescents: a case-control study. Nutr J.14;7:8.
(7)Johnson M et al.  2008.  Omega-3/Omega-6 Fatty Acids for Attention Deficit Hyperactivity Disorder: A Randomized Placebo-Controlled Trial in Children and Adolescents.  J Atten Disord.  Apr 30. [Epub ahead of print]
(8)Sinn N, Bryan J.  2007.  Effect of supplementation with polyunsaturated fatty acids and micronutrients on learning and behavior problems associated with child ADHD. J Dev Behav Pediatr.28(2):82-91.
(9)Effects of an open-label pilot study with high-dose EPA/DHA concentrates on plasma phospholipids and behavior in children with attention deficit hyperactivity disorder.
Sorgi PJ et al.  2007.  Nutr J. 13;6:16.
(10)Richardson AJ.  2004. Long-chain polyunsaturated fatty acids in childhood developmental and psychiatric disorders.  Lipids. 39(12):1215-22.

Written by Ani Kowal

On the 16th July I wrote about artichoke leaf extract (ALE) supplements for cholesterol lowering.  Evidence is also mounting for the usefulness of this plant supplement in the reduction of IBS symptoms (1,2).  In one study (2) 208 adults with IBS were given ALE for a two month period.  The individuals had a significant improvement whilst taking the supplement with a normalising of bowel pattern away from alternating constipation/diarrhoea toward normal.  The IBS sufferers also had a significant improvement in their total health-related quality of life scores.  The trials were small and provide preliminary evidence but it certainly seems that artichoke leaf extract is useful for an array of digestive complaints.  If you decide to try ALE supplements for the management of your IBS symptoms please follow the manufacturers dosage advice, taken in excess it may cause digestive upset.

When discussing IBS it is difficult not to mention the issue of food sensitivities or intolerances.  Some studies indicate that a large proportion of people afflicted with IBS have food sensitivities, very few have true food allergies, and that gas production and other IBS symptoms diminish when the sensitivities are discovered and the offending food(s) eliminated (3,4,5,6).  Assessing sensitivities can be quite subjective and therefore difficult to assess properly in a clinical-trial setting. 

Research suggests that some people with IBS may malabsorb the sugars lactose (found in milk), fructose (found in high concentrations in fruit juice and dried fruit) and sorbitol (found in diabetic and sugar-free products) (7).   Research shows that in a large majority of IBS patients with lactose malabsorption, a lactose-restricted diet can improve symptoms markedly both in the short term and the long term (8).  Fructose- and sorbitol-reduced diets in subjects with fructose malabsorption reduce gastrointestinal symptoms such as bloating, cramps, osmotic diarrhoea and other IBS symptoms (9).  Hence, individuals with IBS attempting to uncover food sensitivities should consider the possibility that milk, fruit juice, dried fruit and products containing sorbitol might cause worsening of their symptoms.

A note of caution – please do not attempt elimination diets without supervision from your GP or a fully qualified professional.  Many ‘food sensitivity tests’ are advertised at very high cost and, in my opinion, can often be unhelpful.  Working with a professional and keeping food diaries and symptom scores may uncover specific triggers for your personal symptoms.  Stress, emotions and psychology may also be playing a major role in your IBS symptoms so assessing how you feel could also prove helpful.  Foods may be triggering symptoms in conjunction with stressful/emotional periods but less-so at other times.

Finally I would like to briefly mention aloe vera juice.  Many individuals with digestive complaints report that their symptoms diminish greatly with the regular ingestion of an aloe vera juice drink or supplemental aloe capsules.  Most of the evidence so far is anecdotal (but that does not lessen personal experiences).  A few animal studies have started to provide weight to the evidence but very few human studies have occurred to date.  A test tube study(10) using human colon cells has shown that aloe vera did appear to work as a potent anti-inflammatory.  You may find it useful to try the juice yourself to see if it is helpful in reducing your personal symptoms.  Remember to follow the dosage guidance and try and keep note of your symptoms for about a week.  If the juice works for you then it is worth continuing with. 

That ends my posts on IBS, I do hope that the information presented over the last few days has been of help?!

(1)Walker AF et al.  2001.  Artichoke leaf extract reduces symptoms of irritable bowel syndrome in post-marketing surveillance study.  Phytotherapy Research.  15:58-61
(2)Bundy R et al.  Artichoke leaf extract reduces symptoms of irritable bowel syndrome and improves quality of life in otherwise healthy volunteers suffering from concomitant dyspepsia: a subset analysis.  J Altern Complement Med.  10:667-669
(3) King TS et al.  1998.  Abnormal colonic fermentation in irritable bowel syndrome.  Lancet.  352:1187-1189
(4) Jones AV et al.  1982.  Food intolerance: a major factor in the pathogenesis of irritable bowel syndrome.  Lancet.  ii:1115-1117
(5) Smith MA et al.  1985.  Food intolerance, atopy, and irritable bowel syndrome.  Lancet.  ii:1064
(6) Parker TJ et al.  1995.  Management of patients with food intolerance in irritable bowel syndrome: the development and use of an exclusion diet.  J Human Nutr Diet.  8:159-166
(7) Fernandez-Banares F et al.  1993.  Sugar malabsorption in functional bowel disease: clinical implications.  Am J Gastroenterol.  88:2044-2050.
(8) Bohmer CJ, Tuynman HA.  2001.  The effect of a lactose-restricted diet in patients with a positive lactose tolerance test, earlier diagnosed as irritable bowel syndrome: a 5-year follow-up study.  Eur J Gastroenterol Hepatol.  13(8):941-944
(9)Ledochowski M et al.  2000.  Fructose- and sorbitol-reduced diet improves mood and gastrointestinal disturbances in fructose malabsorbers.  Scand J Gastroenterol.  35(10):1048-52
(10)Langmead L et al.  2004.  Anti-inflammatory effects of aloe vera gel in human colorectal mucosa in vitro.  Aliment Pharmacol Ther.  19:521-527

Written by Ani Kowal